Provider Demographics
NPI:1346053485
Name:BARLOW, DANYELLE
Entity type:Individual
Prefix:
First Name:DANYELLE
Middle Name:
Last Name:BARLOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 W GENEVA RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1156
Mailing Address - Country:US
Mailing Address - Phone:309-714-1993
Mailing Address - Fax:309-966-3621
Practice Address - Street 1:4450 N PROSPECT RD STE C5
Practice Address - Street 2:
Practice Address - City:PEORIA HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:61616-6578
Practice Address - Country:US
Practice Address - Phone:309-363-7594
Practice Address - Fax:309-966-3621
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.1159081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical